CN1250283C - Combination therapy for eradicating detectable HCV-RNA in patients having chronic hepatitis C infection - Google Patents

Combination therapy for eradicating detectable HCV-RNA in patients having chronic hepatitis C infection Download PDF

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CN1250283C
CN1250283C CNB988093502A CN98809350A CN1250283C CN 1250283 C CN1250283 C CN 1250283C CN B988093502 A CNB988093502 A CN B988093502A CN 98809350 A CN98809350 A CN 98809350A CN 1250283 C CN1250283 C CN 1250283C
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J·K·阿尔布雷克特
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Abstract

There is disclosed the use of ribavirin, interferon alpha or a combination of ribavirin and interferon alpha for the manufacture of a pharmaceutical composition for treating a patient having chronic hepatitis C infection to eradicate detectable HCV-RNA by a method comprising administering an effective amount of ribavirin in association with an effective amount of interferon alpha, wherein the patient is one having failed to respond to a previous course of interferon alpha therapy. The compositions may be used in a method for treating a patient having chronic hepatitis C infection to eradicate detectable HCV-RNA involving a combination therapy using a therapeutically effective amount of ribavirin and a therapeutically effective amount of interferon-alpha for a time period of from 20 up to 80 weeks.

Description

The therapeutic alliance of eradicating detectable HCV-RNA in patients having chronic hepatitis C infection
The chronic infection of hepatitis C virus is the disease of latent and chronic development, and it has remarkable influence to quality of life.It finally causes liver cirrhosis, decompensation hepatopathy and/or hepatoma.
Interferon-alpha treatment separately is commonly used to treat chronic hepatitis C infection.But this treatment always effectively and does not sometimes cause the side effect relevant with dosage and treatment time that can not tolerate.Advised that ribavirin (ribavirin) is as to the independent treatment of hepatitis C infection (hepatopathy Vol.20, NO.4, Pt2, Number 440,1994 for Thomas etc., AASLD summary).Yet, found this independent normal relative nullity of treatment and disadvantageous side effect arranged himself.Someone advises the therapeutic alliance (Lai etc., the 9th two annual scientific and technical conference liver research symposiums of Asia-Pacific community (Symposium to the 9thBiennial Scientific Meeting Asian Pacific Association for theStudy of the Liver.) 1994) of interferon-alpha and ribavirin.This therapeutic alliance of preliminary results suggest may be more effective than each independent treatment, Hay den FG, Schlepushkin AN.Experiment in vitro use in conjunction IF2 a, rimantadine hydrochlorate and ribavirin can suppress duplicating of influenza virus, Antimicrob Agents Chemother.1984; 25:53-57.SchVarcz R, AndoY, Snnerborg A, Weiland O. uses Interferon Alpha-2b and ribavirin therapy chronic hepatitis C patient, and these patients do not reach lasting reaction to independent interferon: Swedish experience.J Hepatology.1995; 232 (Suppl 2): 17-21.Brouwer JT, Nevens F, Michielsen P etc.When not reacting interferon, hepatitis C also has what selection? ratio Lu (Benelux) multicenter of placebo therapeutic test is again treated separately with comparing J.Hepatol.1994 with the interferon therapeutic alliance ribavirin; 212 (Suppl 1): S17.Ab stract WP2/08.ChemelloL.Cavalletto L, Bernardinello E etc.The chronic hepatitis C patient to the reaction of ribavirin, interferon and the two use in conjunction and with the genotypic relation of HCV, JHepatol.1994; 212 (Suppl 1): S12.Abstract GS5/29.But nobody describes with any secular, effective and efficient manner goes out except that the method for HCV-RNA with interferon-alpha and ribavirin.
Really need be with any secular, effective and efficient manner with interferon-alpha and ribavirin therapeutic alliance chronic hepatitis C infection to go out except that the method for HCV-RNA.
Summary of the invention
According to an aspect of of the present present invention, provide ribavirin to treat the chronic hepatitis C infection patient to go out except that the purposes in the pharmaceutical composition of detectable HCV-RNA in preparation, above-mentioned Therapeutic Method uses the ribavirin of the effective dose of uniting with the interferon-alpha of effective dose, and wherein this patient is reactionless to the interferon-alpha treatment in early stage.
According to another aspect of the present invention, provide interferon-alpha to treat the chronic hepatitis C infection patient to go out except that the purposes in the pharmaceutical composition of detectable HCV-RNA in preparation, above-mentioned Therapeutic Method uses the interferon-alpha of the effective dose of uniting with the ribavirin of effective dose, and wherein this patient is reactionless to the interferon-alpha treatment in early stage.
The present invention also provides ribavirin and interferon-alpha to treat the chronic hepatitis C infection patient to go out except that the purposes in the pharmaceutical composition of detectable HCV-RNA in preparation, above-mentioned Therapeutic Method uses the ribavirin of the effective dose of uniting with the interferon-alpha of effective dose, and wherein this patient is reactionless to the interferon-alpha treatment in early stage.
These pharmaceutical compositions remove detectable HCV-RNA to treatment chronic hepatitis C infection patient to go out and have special purposes, be included in the interferon-alpha of the ribavirin with the treatment effective dose that use the treatment effective dose in 20 to 30 weeks, so that at least 30% patient does not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, there is not detectable HCV-RNA at least in 24 weeks yet.Preferably do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, do not have detectable HCV-RNA at least in 24 weeks yet at least about 40% patient.
In another embodiment, they can be used for treating the chronic hepatitis C infection patient and remove detectable HCV-RNA to go out, be included in the interferon-alpha of the ribavirin with the treatment effective dose that use the treatment effective dose in 40 to 50 weeks, so that do not have detectable HCV-RNA in described 40 to the 50 treatment end of term in week, after described administration, there is not detectable HCV-RNA at least in 24 weeks at least about 40% patient yet.Preferably do not have detectable HCV-RNA in described 40 to the 50 treatment end of term in week, after described administration, do not have detectable HCV-RNA at least in 24 weeks yet at least about 50% patient.
In another embodiment, they can be used for treating the chronic hepatitis C infection patient and remove detectable HCV-RNA to go out, be included in the interferon-alpha of the ribavirin with the treatment effective dose that use the treatment effective dose in 60 to 80 weeks, so that do not have detectable HCV-RNA in described 60 to the 80 treatment end of term in week, after described administration, there is not detectable HCV-RNA at least in 24 weeks at least about 50% patient yet.Preferably do not have detectable HCV-RNA in described 60 to the 80 treatment end of term in week, after described administration, do not have detectable HCV-RNA at least in 24 weeks yet at least about 60% patient.
In another embodiment, they can be used for treating the chronic hepatitis C infection patient and remove detectable HCV-RNA to go out, this patient has the HCV genotype of non-1 type and is less than or equal to every milliliter in 200 ten thousand copies by the quantity of viruses in its serum of HCV-RNA quantitative PCR detection, be included in the interferon-alpha of the ribavirin with the treatment effective dose that use the treatment effective dose in 20 to 30 weeks, so that at least 60% and preferred at least 70% patient does not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, there is not detectable HCV-RNA at least in 24 weeks yet.Preferably do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, do not have detectable HCV-RNA at least in 24 weeks yet at least about 80% patient.
In another embodiment, they can be used for treating the chronic hepatitis C infection patient and remove detectable HCV-RNA to go out, this patient has the HCV genotype of non-1 type and detects quantity of viruses in its serum greater than 200 ten thousand copies by HCV-RNA/qPCR, be included in the interferon-alpha of the ribavirin with the treatment effective dose that use the treatment effective dose in 20 to 30 weeks, so that do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, there is not detectable HCV-RNA at least in 24 weeks at least about 50% patient yet.Preferably do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, do not have detectable HCV-RNA at least in 24 weeks yet at least about 60% patient.
In another embodiment, they can be used for treating the chronic hepatitis C infection patient and remove detectable HCV-RNA to go out, this patient has the HCV genotype of 1 type and the quantity of viruses that detects in its serum by HCV-RNA/qPCR is less than or equal to 200 ten thousand copies, be included in the interferon-alpha of the ribavirin with the treatment effective dose that use the treatment effective dose in 20 to 30 weeks, so that do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, there is not detectable HCV-RNA at least in 24 weeks at least about 30% patient yet.Preferably do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, do not have detectable HCV-RNA at least in 24 weeks yet at least about 40% patient.
In another embodiment, they can be used for treating the chronic hepatitis C infection patient and remove detectable HCV-RNA to go out, this patient has the HCV genotype of 1 type and detects quantity of viruses in its serum greater than 200 ten thousand copies by HCV-RNA/qPCR, be included in the interferon-alpha of the ribavirin with the treatment effective dose that use the treatment effective dose in 20 to 30 weeks, so that do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, there is not detectable HCV-RNA at least in 24 weeks at least about 15% patient yet.Preferably do not have detectable HCV-RNA in described 20 to the 30 treatment end of term in week, after described administration, do not have detectable HCV-RNA at least in 24 weeks yet at least about 20% patient.
Preferred ribavirin dosage is that every day 400 is to 1200mg.More preferably the ribavirin dosage is that every day 800 is to 1200mg.
The interferon-alpha of using is preferably selected from the interferon-alpha product or the Pegylation interferon-alpha of interferon-' alpha '-2a, interferon-' alpha '-2b, IFN-con (consensus interferon), purification.More preferably, interferon-alpha is selected from the interferon-alpha goods of interferon-' alpha '-2a, interferon-' alpha '-2b or purification, and the interferon-alpha dosage is 200 ten thousand to 1,000 ten thousand IU weekly, by week on every Wendesdays time, per diem count single administration every other day.In preferred embodiments, the interferon-alpha of use is interferon-' alpha '-2b, and the interferon-alpha dosage is that 300 ten thousand IU are inferior on every Wendesdays.
Perhaps, the interferon-alpha of use is an IFN-con, and the interferon-alpha use amount be 1 to 20 microgram weekly, by week on every Wendesdays time, per diem meter is every other day once.In another embodiment, the interferon-alpha of use is pegylated interferon alfa-2b, the use amount of this interferon-alpha be 0.5 to 2.0 microgram/kilogram weekly, by week on every Wendesdays time, per diem meter is every other day once.Perhaps, the interferon-alpha of use is pegylated interferon alfa-2a, the interferon-alpha use amount be 20 to 250 microgram/kilograms weekly, by week on every Wendesdays time, per diem meter is every other day once.
The present invention is surprisingly found out that, treat comparison separately with interferon-alpha or ribavirin, at least 20 to 30 weeks of interferon-alpha therapeutic alliance of the ribavirin of treatment effective dose and treatment effective dose, can cause the patient of more any independent treatment more than 10 times after treatment finishes at least 24 weeks its serum do not have detectable HCV-RNA.
Detailed Description Of The Invention
Term " interferon-alpha " is used for this paper and refers to height congener specific proteins family, and this albumen suppresses virus replication and cell proliferation and regulates immunoreation.Typical suitable interferon-alpha includes but not limited to Interferon Alfa-2b, as the Intron-A interferon, by ScheringCorporation, Kenilworth, N.J. provide, Interferon Alfa-2a, as the Roferon interferon, by Hoffmann-La Roche, Nutley, N.J. provides, recombinantinterferon-2C, as Berofor α 2 interferon, by Boehringer IngelheimPharmaceutical, Inc., Ridgefield, CT. provide, interferon alfa-n1, a kind of purified mixture of natural interferon-alpha is as Sumiferon, Sumitomo by Japan provides, or Wellferon interferon-n1 (INS), by Glaxo-Wellcome Ltd., London, Britain provides, perhaps consensus sequence interferon-alpha such as United States Patent (USP) 4897471 and 4695623 (particularly embodiment 7,8 or 9) are described, and by Amgen, Inc., the certain products that Newbury Park, CA provide, or produce by PurdueFredreick Co. by Interferon Sciences, a kind of mixture Alferon N of the natural interferon-alpha that Norwalk, CT. provide with the Alferon trade mark.Preferred Intederon Alpha-2a and the α-2b of using.Because interferon alpha 2 b has obtained approval the most widely in the whole world in the treatment chronic hepatitis C infection in all interferon, is most preferred therefore.The preparation of interferon alpha 2 b is described in United States Patent (USP) 4530901.
Ribavirin, 1-D-ribofuranosyl-1H-1,2,4-triazole-3-Methanamide, by ICNParmaceuticals, Inc., Costa Mesa, California provides, it is described in Merck Index, compound N o.8199, the 11st edition.Its preparation and preparation are described in United States Patent (USP) 4211771.
" to previous tretament do not have the reaction " refer to the early stage the nonreactive at all patient of treatment (this area is commonly referred to as " nonresponder "), or to previous tretament respond but subsequently the recurrence patient's (this area is commonly referred to as " non-sustained response person ").
" be difficult to treat the patient " and be not easy patient that treatment is reacted to being classified as so far; For example because high quantity of viruses or since HCV infect be the genotype that is difficult to treat as 1 type, 1b type for example.HCV is divided into the details of independently genotypic classification to be seen, for example, and " by the system to the NS-5 district analysis takes place hepatitis C virus is divided into six kinds of main genotype and a series of hypotype ", Simmonds, P. etc., J.Gen Virol. (1993), 74,2391-2399 and " the suggestion system of hepatitis c virus genotype name ", Simmonds, P. etc., Hepatology, 19 (5) (1994), 13221-1323.
The patient of chronic hepatitis C infection may show one or more following S or Ss:
(a) ALT raises,
(b) the HCV antigen/antibody combination test is positive,
(c) HCV-RNA detects the positive and shows and have HCV,
(d) Clinical symptoms of the dirty disease of chronic hepatitis,
(e) hepatocyte injury.
In order to implement the present invention, give the patient who shows above-mentioned one or more S or Ss, to be enough to eliminate or alleviate at least the amount of one or more S or Ss, use interferon-alpha (hereinafter to be α-IFN) and ribavirin.In preferred embodiments, use therapeutic alliance of the present invention to the patient that can not eliminate HCV-RNA after the independent treatment of interferon-alpha.
Unite to the patient and to use α-IFN and ribavirin, promptly in this patient accepts same time of ribavirin, use α-IFN.Most α-the IFN preparation oral is invalid, and therefore preferred α-the IFN administering mode is a parenteral, preferably subcutaneous, IV or IM injection.Ribavirin can be with the α-IFN of parenteral, with the form oral administration of capsule or tablet.Certainly, can consider other form of medication of two kinds of medicines, as by intranasal spraying, percutaneous dosing, by suppository, by administrations such as slow release formulations.Do not destroy active constituent as long as use suitable dosage form, any form of administration is feasible all just.
In text of the present invention, detectable HCV-RNA refers to detect by quantitative, many circulation reverse transcriptions enzyme PCR method, and every milliliter of patients serum is less than 100 copies.HCV-RNA preferably detects by following method in the present invention.The method is referred to herein as HCV-RNA/qPCR.
Mix (mister) with guanidine thiocyanate-phenol-chloroform, precipitate by extracting RNA among the patients serum with ethanol-ammonium acetate then.Sedimentary RNA is centrifugal and with granular Centrivap operating board (Labconco, Kansas City, Mo.) drying of being deposited in.Then, with exsiccant granular precipitation resuspending in the Rnasin of 30 microlitres (Promega Corp., Madison, WI), in the aqueous mixtures handled of dithiothreitol, DTT and Ue-5908.Sample is remained on below-20 ℃ until RNA reverse transcription (RT) and PCR.
For in reverse transcription reaction, whole RNA sequences are changed into cDNA, (Pharmacia Biotech, Piscataway is NJ) as the synthetic primer of article one cDNA for six Deoxydization nucleotides at random.The resuspending sample of two five equilibriums, 3 microlitres is joined in the 100ng/L random primer of 3 microlitres and 70 ℃ of degeneration, (OH) reverse transcription is 1 hour for USB, Cleveland with the M-MLV reverse transcriptase in 40 ℃ of standard buffer solutions that containing the 5mM magnesium chloride then.Final reverse transcription reaction volume is 26L.Begin PCR behind the reverse transcription immediately.
The PCR method of carrying out improved form with thermostable Taq polymerase is with amplification cDNA.Add 75 microlitre PCR mixture in whole reverse transcription reaction volumes (26L), extremely the magnesium chloride ultimate density in cumulative volume 101L is 1.5mM.Each 101L sample is further divided into the sample of 50.5L, and adds that on top mineral oil is to avoid evaporating.
The PCR circulation was made up of annealing 90 seconds, amplification 90 seconds and degeneration in 90 seconds, respectively at 55 ℃, 74 ℃ and 94 ℃.The thermal cycle sample is carried out last 74 ℃ of amplifications 10 minutes.Use four different circulating device.Repeat to add sample, and coequally these samples are separated behind RT, each sample is divided into four test tubes.In these four test tubes each provides different periods, improves the sensitivity and the accuracy of this quantitative approach.Count the efficient of the satisfied amplification evaluation thermal cycle of RNA reference material by the known copy that comprises 60 test tubes of every cover.Carry out this amplification with two cover primers, they are all from the genomic 5 ' untranslated region of HCV.All known hypotypes of HCV are carefully preserved and detected to these two pairs of primers.Primer is to 1: upstream 5 '-GTG GTC TGC GGA ACCGGT GAG T3 ', downstream 5 '-TGC ACG GTC TAC GAG ACC TC-3 ', it has prepared the product of 190bp.Primer is to 2: upstream 5 '-CTG TGA GGA ACT ACT GTC TTC-3 ', downstream 5 '-CCC TAT CAG GCA GTA CCA CAA-3 ', it has prepared the product of 256bp.
Then, with cDNA electrophoresis and being transferred on the nylon membrane on 3% agarose gel of amplification.Detect target DNA by Southern trace and immunostaining with the dna probe of "dead" digoxigenin labelling.Carry out operation sequences such as PCR thermal cycle, agarose gel electrophoresis, vacuum transfer Southern trace, hybridization and immunostaining with robot.Each film contains the reference material of the serial dilution of known copy number, and they are used to set up standard curve with detection by quantitative sample band.The HCV-RNA that is transcribed the clone by deriving from of careful dilution makes the primary standard curve.Transcript is carried out radioactivity mix test, gel electrophoresis and OD 260, arrived the length of expectation so that determine them.Quantitatively after the rna transcription thing preparation of clone's reference material, the reference material of " collection " has produced, and it has represented the heterogeneity of HCV better, and people can run in natural infection.These gleanings are by mixing serum or the blood plasma preparation that derives from known infected individuals in a large number.These blood serum gleanings, dilute in known PCR negative fluid at the calibration of clone's transcript then with PCR.At last, the sample Chiron INc. than high copy number of gleanings (Emeryville, cDNA Quantiplex nucleic acid detection system inspection CA).These " two quantitative " gleanings are divided into five equilibrium and-70 ℃ of preservations.In each test, use the dilution factor of 5000000,1000000,500000,100000,10000 and 1000 copies/ml.
In the interval of reaction, each Southern blotting membrane scanned in the computer, with automatic scanner/densimeter to determine when the most approaching linearity of standard curve.From the gained electronic image, measure the long-pending and average band density of zone face again.All reading standardization are compared with integral strip density and with standard curve, to obtain the value of viral copy number in every band.
Carry out following clinical protocol:
Research 1:
Global design of this experiment and plan
This be perspective, multicenter, at random, double blinding, parallel group of research.This experiment is INTRON relatively A adds ribavirin and INTRON A adds the result in 24 weeks of chronic hepatitis C patient compensatory phase of placebo treatment, and these patients are to interferon-alpha (INTRON A, Roferon -A or Wellferon ) respond one or two course of treatment in early stage (minimum 3MU to maximum 6MU 1 time or 3 times weekly every other day, at least 20 thoughtful maximum 18 months), but nearest interferon-alpha treatment back recurrence.Determine to suffer from the qualified patient of chronic hepatitis C by the serum HCV-RNA positive, liver biopsy and lab testing.
The patient uses INTRON at random A adds ribavirin or INTRON A adds placebo treatment.INTRON The dosage of A is that 3MU is subcutaneous inferior on every Wendesdays; The dosage of ribavirin is 1000 or 1200mg oral every day (according to body weight), divides rechallenge.By central authorities at random the center with same ratio TA group.The random method of design is used for the balance therapy group: in the site or by the site, according to having or not hepatitis interstitialis chronica, serum HCV-RNA/qPCR level and HCV genotype in the liver biopsy before the treatment.
Experimental therapy carried out for 24 weeks.Total process of experiment is the long terms of 48 weeks clearly to treat.
During treating and after the treatment, follow up a case by regular visits to biochemistry (ALT), virusology (HCV-RNA) and histology's (liver biopsy) etc. and check that evaluation is to experimental therapy reaction properties and time.When 24 weeks were detected after treatment, the variable of main effect is the disappearance that the is defined as serum HCV-RNA/qPCR (W-response of＜100 copies/ml), and the liver biopsy result improvement of treatment back, detect by Knodell histology activity index (Knodell Histology Activity index (HAI)).Also detected the normalization of ALT as the secondary effect variable.The safety of this experimental therapy is by the laboratory parameters of monitoring selection and estimating of record and assessment side effect.
Therapeutic scheme
The experimental therapy scheme has two kinds:
-INTRON A 3MU is subcutaneous on every Wendesdays time, and it is oral to add ribavirin 1000 to 1200mg/ days, with two dosage that separate, and 24 weeks of administration; Or
-INTRON A 3MU is subcutaneous inferior on every Wendesdays, with the oral placebo that is complementary of the ribavirin of the dosage that separates with two, 24 weeks of administration.
24 weeks of experimental therapy administration.Use the standard I NTRON of treatment hepatitis C with fixed dosage 3MU TIW A (Interferon Alfa-2b) dosage regimen.Each patient accepts to instruct and subcutaneous use INTRON according to preparation A.Sooner or later use ribavirin twice every day.Weight in patients by record is determined dosage.The patient that body weight is 75 kilograms accepts 1000mg every day, promptly morning two 200mg capsule, evening three 200mg capsule.Body weight is accepted 1200mg every day greater than 75 kilograms patient, i.e. the capsule of each three 200mg of morning and evening.
The design random method is with the balance group relevant with following basic characteristic:
A. liver histological (hepatitis interstitialis chronica or do not have hepatitis interstitialis chronica) before the treatment;
B. serum HCV-RNA/qPCR situation (HCV-RNA/qPCR 2000000 or HCV-RNA/qPCR＞2000000 copy/ml); And
C.HCV genotype (1 type or other).The patient that will mix genotype (comprising 1 type) for balance is categorized as 1 type.
Effect
Primary effect target is to compare two treatment groups according to the complete reaction rate, be defined as and finish 24 week back serum HCV-RNA/qPCR in treatment and reduce to level that detection do not go out or, press the improvement of liver biopsy result after treatment that the scoring of Knodell HAI inflammation defines simultaneously less than 100 copy/ml levels.Also detect following secondary effect terminal point:
The secondary effect terminal point:
D. follow up a case by regular visits to 24 when week the part patient ALT normalization;
E. part patient's biopsy make moderate progress (classification I+II+III comprehensive grading);
F. the biopsy scoring changes (classification I+II+III comprehensive grading) to some extent than basic value;
G. in the response rate for the treatment of terminal point HCV-RNA/qPCR;
H. in the ALT normalization for the treatment of terminal point part patient.
I. follow up a case by regular visits to 24 when week HCV-RNA/qPCR response rate.
Virusology: the characteristic of registration and the variation when registering certainly
Carrying out serum HCV-RNA/qPCR by central laboratory detects.Need male HCV-RNA testing result in basic value; Have only the male patient of HCV-RNA to be eligible for.At 4,12,24 week and 12 and 24 all replications of following up a case by regular visits to.
By with the evaluation response of giving a definition:
Responder: if, then the patient is defined as responder at the time point HCV-RNA/qPCR feminine gender that provides (every milliliter in＜100 copies).
Sustained response person: if the patient then is defined as sustained response person with this patient for responder when following up a case by regular visits to for 24 weeks.
Note not meeting the patient of these standards, the patient of drug withdrawal before the HCV-RNA/qPCR that is included in requirement estimates and obtains is as the nonresponder.
Complete reaction person: the variation of the liver histological of estimating according to serum HCV-RNA/qPCR with by Knodell HAI inflammation scoring.If this patient has improved 2 minutes or more for sustained response person and with respect to its treatment back Knodell HAI inflammation scoring (classification I+II+III sum) before the treatment, then this patient is defined as treatment complete reaction person.
Liver histological
When the patient registers in preceding 6 months and followed up a case by regular visits to for 24 weeks after treatment, need liver biopsy.Carry out bioptic evaluation by a pathologist with the active scoring of Knodell histology.Patient's identity, treatment group and the biopsy time that obtains with respect to treatment (before or after the treatment) are not known by central pathology review man.The effect of experimental therapy by relatively when the basis and the degree of treatment back observed inflammatory activity during 24 weeks estimate.
The result
Registered 195 patients and be divided at random and use INTRON at 31 International Centres A adds ribavirin (N=98) or INTRON A adds placebo (N=97) treatment.3 patients do not treat, and wherein accept INTRON at random for two A adds ribavirin, and 1 is accepted INTRON at random A adds placebo; Therefore, all treatment group is made up of 192 patients and (is accepted INTRON A adds ribavirin and INTRON What A added placebo respectively has 96 patients).These three two people that do not treat among the patient are because do not wish to continue treatment, and the 3rd is because do not meet the standard of scheme.The data that all effect and safety discussion are based on all treatment groups in this report.
Effect
The purpose of this research is comparison INTRON A adds ribavirin and INTRON A adds the complete reaction rate and the virusology response rate (based on HCV-RNA/qPCR) of placebo.The main effect variable of this experiment is the complete reaction rate.
The conclusion that draws according to effect is as follows:
J. unite ribavirin and INTRON A can increase the ratio that goes out except that the patient of HCV-RNA significantly, and the hepatitis inflammation is significantly reduced.
Following up a case by regular visits to terminal point complete reaction rate changes and forms by the elimination of serum HCV-RNA (qPCR) with following up a case by regular visits to terminal point (treatment finishes 24 weeks of back) liver histological.If after treatment the negative and treatment back of 24 all HCV-RNA (qPCR) before the treatment Knodell HAI inflammation scoring (the I+II+III sum of classifying) improved 2 units or more, then this patient is confirmed as complete reaction person.Virusology reaction, histologic reaction and the complete reaction rate of following up a case by regular visits to terminal point are summarized in table 1,2 and 3.
Follow up a case by regular visits to terminal point HCV-RNA reaction: treatment finishes the lasting disappearance of back HCV-RNA during 24 weeks
Use INTRON A adds ribavirin therapeutic alliance group and accepts INTRON A treatment group is separately compared, treatment finish HCV-RNA in the 24 all serum of back go out the patient's that removes ratio big ten times (p＜0.001).Table 1 has been summed up the reaction of following up a case by regular visits to terminal point patients serum HCV-RNA.
Table 1 is followed up a case by regular visits to terminal point serum HCV-RNA: finish the go out patient's that removes ratio of back 24 all HCV-RNA in treatment
Patient's reactive state Patient's number (%) The p value
INTRON A adds ribavirin INTRON A adds placebo
Responder when the difference treatment between the 95% confidence interval treatment of every group of treatment of all patients that receive treatment finishes c 50/96 (52) 4％-58％ 42％-62％ 49/80 (61) 5/96 (5) 1％-10％ ? 5/41 (12) ＜0.001
INTRON before and after the treatment A adds the ribavirin therapy group has 81% (78/96) to carry out biopsy, accepts INTRON A adds placebo group 77% (74/96) and has carried out biopsy.Table 2 has been summed up the effect of treatment to hepatitis, comprises the liver biopsy result of treatment front and back.Since the lasting disappearance that HCV-RNA duplicates, therapeutic alliance group and INTRON A treatment group separately compares, and patient's ratio that the liver inflammation is improved significantly increases (p＜0.001).
Table 2 is followed up a case by regular visits to the terminal point liver histological: finish the improvement of 24 weeks of back according to KnodellHAI (I+II+III) scoring liver histological in treatment
Patient's states Patient's number (%) b The p value c
INTRON A adds ribavirin (n=78) INTRON A adds placebo (n=74)
Biopsy improves d 49(51) 30(31) ＜0.001
B has accepted the bioptic patient in treatment front and back.
C Fisher ' s Precision Test.
To the variation of treatment back Knodell histology's index (HAI) scoring (I+II+III sum), reduced by 2 or more before the treatment before the d treatment.
Complete reaction
During contrived experiment, should recognize, can not obtain the liver biopsy after all patients' the treatment because liver biopsy is invasive operation.Therefore, record and statistical analysis plan are specified will be treated patient's data based on all to the analysis of complete reaction, and estimate the patient that its complete reaction can not be determined by maximum likelihood method (MLE), i.e. negative the and patient that do not have (treatment back) biopsy to estimate of HCV-RNA.Record also specifies the patient's (being data patients completely) to treatment front and back biopsy results is arranged to carry out supplement Analysis.Based on following analysis, complete reaction is summarized in table 3.
K. maximum likelihood evaluation (MLE);
L. the patient of data integrity (have treatment before and after biopsy results);
M. the patient of data disappearance one of (HCV/ biopsy the two or all) writes off.
Table 3 complete reaction rate
Data analysis INTRON A adds ribavirin INTRON A adds placebo The p value b
The patient that the maximum likelihood evaluating data is complete cThe data disappearance writes off d 43％ 39/78(50％) 39/96(41％) 5％ 4/74(5％) 4/96(4％) ＜0.001 ＜0.001 ＜0.001
1.MLE return based on logarithm.
1.Fisher ' s Precision Test.
1. the biopsy results before and after the partial data=treatment.
1. the patient of one of virusology or biopsy data or whole disappearances counts failure.
With go out and improve outcome expectancy separately from following up a case by regular visits to terminal point HCV-RNA except that the scorching disease of regulating liver-QI, therapeutical effect is the same as all evaluation methodologys, and at INTRON The result that A adds the placebo group observation compares INTRON A adds the complete reaction rate obviously bigger (＜0.001) of ribavirin therapy group, has obtained 10 to 14 times improvement.
On the basis of all basic demographic variables and genius morbi, carry out the logarithm regression analysis.It is that genotype is not that 1 type and quantity of viruses are 200 ten thousand that the feature terminal point sustained response, unique, that statistical significance is arranged is followed up a case by regular visits in prediction.
For viral copy number (200 ten thousand,＞2 hundred ten thousand), the patients that significant difference is supported in 200 ten thousand copies have higher response rate (table 4).
When in conjunction with genotype and basic quantity of viruses, observe fractional order reaction.Genotype is not that 1 type and basic quantity of viruses are that 200 ten thousand patients that copy have the best end reaction of following up a case by regular visits to; Genotype be 1 type and＞200 ten thousand the copy patients have the poorest end reaction of following up a case by regular visits to.
Table 4 genius morbi and sustained response: the patient of all treatments
Genius morbi b Patient's number (%)
INTRON A adds ribavirin (n=96) ?INTRON A adds placebo (n=96)
HCV-RNA/aPCR200 ten thousand 2 hundred ten thousand The HCV genotype c1 other Genotype/basic HCV-RNA/aPCROther/200 ten thousand copies other/＞2 hundred ten thousand copies 1,200 ten thousand copies 1＞200 ten thousand copy ? 24/36(67) 26/60(43) ? 16/53(30) 34/43(79) ? 15/16(93) 18/27(67) 8/20(40) 7/33(21) ? 5/29(17) 0/67(0) ? 2/53(4) 3/19(7) ? 3/14(21) 0/29(0) 0/15(0) 0/38(0)
B is in when registration, by viral copy number (200 ten thousand,＞2 hundred ten thousand), genotype (1 type or other) and hepatitis interstitialis chronica (have or do not have) classification.
Research 2:
By with the experiment 1 described substantially the same method, carry out second experiment.The result is summarized as follows.
Effect
Treatment terminal point complete reaction rate is changed by the disappearance of serum HCV-RNA (qPCR) and the liver histological of following up a case by regular visits to terminal point (treatment finished for 24 weeks) to be formed.If treatment finish the negative and treatment back of back 24 all HCV-RNA (qPCR) before the treatment Knodell HAI inflammation scoring (the I+II+IIl sum of classifying) improved 2 units or more, then this patient is confirmed as complete reaction person.Follow up a case by regular visits to the reaction of terminal point virusology, histologic reaction and complete reaction rate and be summarized in table 5,6 and 7.
Follow up a case by regular visits to terminal point HCV-RNA reaction two treatments and finish back the continuing to go out and remove of HCV-RNA during 24 weeks
Use INTRON A adds the patient of ribavirin therapeutic alliance and accepts INTRON The A patient of treatment separately compares, and treatment finishes to go out except that big ten times of patient's ratios (p＜0.001) of HCV-RNA in the 24 all serum of back.Reaction when following up a case by regular visits to terminal point that table 5 has summed up that serum HCV-RNA shows.
Table 5 is followed up a case by regular visits to terminal point serum HCV-RNA: finish the go out patient's that removes ratio of back 24 all HCV-RNA in treatment
Patient's reactive state Patient's number (%) The p value
INTRON A adds ribavirin INTRON A adds placebo
All patients that receive treatment are for the responder of the difference treatment terminal point of 95% confidence interval between treatment of each treatment c 34/77(44) 33％-56％ ? 28％-52％ 34/54(63) 3/76(4) 0％-8％ ? ? 3/32(9) ＜0.001
Follow up a case by regular visits to the terminal point liver histological: based on Knodell histology activity index (HAI) scoring (I+II+III), treatment finishes the improvement of back 24 all liver histologicals
INTRON before and after the treatment A adds the ribavirin therapy group has 79% (61/77) to carry out biopsy, accepts INTRON A adds placebo group has 84% (64/76) to carry out this inspection.Table 6 has been summed up the effect of treatment to hepatitis, comprises the liver biopsy result of treatment front and back.Because the lasting disappearance that HCV-RNA duplicates is accepted the therapeutic alliance group and is accepted INTRON A treatment group separately compares, and the patient's that the liver inflammation is improved ratio significantly increases (p＜0.001).
Table 6 is followed up a case by regular visits to the terminal point liver histological: finish the improvement of 24 weeks of back based on the liver histological of KnodellHAI (I+II+III) scoring in treatment
Patient's states Patient's number (%) a The p value b
?INTRON A adds ribavirin (n=61) ?INTRON A adds placebo (n=64)
Biopsy improves c ?38(49) ?27(36) ＜0.001
2. accepted the bioptic patient in treatment front and back.
2.Fisher ' s Precision Test.
2. the extremely variation of treatment back Knodell histology's index (HAI) scoring (I+II+III sum) before the treatment has reduced by 2 or more before treating.
Complete reaction
Complete reaction based on following analysis is summarized in table 7:
N. maximum likelihood evaluation (MLE);
O. the patient of data integrity (have treatment before and after biopsy results);
P. the patient of data disappearance one of (HCV/ biopsy the two or all) writes off.
Table 7 complete reaction rate
Data analysis INTRON A adds ribavirin INTRON A adds placebo The p value b
Maximum likelihood is estimated aThe patient of data integrity cThe data disappearance writes off d 36.5％ 25/61(41.0％) 25/77(32.5％) 2.7％ 2/64(3.1％) 2/76(2.6％) ＜0.001 ＜0.001 ＜0.001
1.MLE return based on logarithm.
1.Fisher ' s Precision Test.
1. the biopsy results before and after the partial data=treatment.
1. the patient of one of biopsy data or whole disappearances counts failure after the virusology.
With from follow up a case by regular visits to terminal point HCV-RNA go out remove the same with the therapeutical effect of the outcome expectancy separately that the liver inflammation is improved, for all evaluation methodologys, and at INTRON The result that A adds the placebo group observation compares INTRON A adds the complete reaction rate obviously bigger (＜0.001) of ribavirin therapy group, has obtained 10 to 14 times improvement.
On the basis of all basic demographic variables and genius morbi, carry out the logarithm regression analysis.It is that genotype is not 1 type that the feature terminal point sustained response, unique, that statistical significance is arranged is followed up a case by regular visits in indication.
For viral copy number (200 ten thousand,＞2 hundred ten thousand), the patients that significant difference is supported in 200 ten thousand copies have higher response rate (table 8).When in conjunction with genotype and basic quantity of viruses, observe fractional order reaction.Genotype is not that 1 type and basic quantity of viruses are that 200 ten thousand patients that copy have the best end reaction of following up a case by regular visits to; Genotype be 1 type and＞200 ten thousand the copy patients have the poorest end reaction of following up a case by regular visits to.
Table 8 genius morbi and sustained response: the patient of all treatments
Genius morbi Patient's number (%)
?INTRON A adds ribavirin (n=77) ?INTRON A adds placebo (n=76)
? HCV-RNA/qPCR200 ten thousand 2 hundred ten thousand The HCV genotype1 other Genotype/basic HCV-RNA/qPCROther/200 ten thousand copies other/＞2 hundred ten thousand copies 1/,200 ten thousand copies 1/＞200 ten thousand copy ? ?6/9(67) ?28/68(41) ? ?12/46(28) ?21/31(68) ? ?4/4(100) ?17/27(62) ?2/5(40) ?11/39(28) ? ?1/12(8) ?2/64(3) ? ?1/42(2) ?2/34(6) ? ?0/3(0) ?2/31(6) ?1/9(11) ?0/32(0)
Only be for example, the present invention only limits by following claim and with four corner that these claimed claim are equal to.

Claims (5)

1. ribavirin is treated the chronic hepatitis C infection patient to go out except that the purposes in the pharmaceutical composition of detectable HCV-RNA in preparation, above-mentioned treatment is by using the ribavirin of the effective dose of uniting with the interferon alpha 2 b of effective dose, wherein be 40-50 week or 60-80 week action time, wherein this patient is reactionless to the interferon-alpha treatment in early stage, it is characterized in that described patient is greater than 200 ten thousand copies by every milliliter of serum-virus loading of HCV-RNA quantitative PCR detection, and be the patient that 1 type HCV genotype infects.
2. interferon-alpha is treated the chronic hepatitis C infection patient to go out except that the purposes in the pharmaceutical composition of detectable HCV-RNA in preparation, above-mentioned treatment is by using the interferon alpha 2 b of the effective dose of uniting with the ribavirin of effective dose, wherein be 40-50 week action time, wherein this patient is reactionless to the interferon-alpha treatment in early stage, it is characterized in that described patient is greater than 200 ten thousand copies by every milliliter of serum-virus loading of HCV-RNA quantitative PCR detection, and be the patient that 1 type HCV genotype infects.
3. ribavirin and interferon alpha 2 b are treated the chronic hepatitis C infection patient to go out except that the purposes in the pharmaceutical composition of detectable HCV-RNA in preparation, above-mentioned treatment is by using the ribavirin of the effective dose of uniting with the interferon alpha 2 b of effective dose, wherein be 40-50 week action time, wherein this patient is reactionless to the interferon-alpha treatment in early stage, it is characterized in that described patient is greater than 200 ten thousand copies by every milliliter of serum-virus loading of HCV-RNA quantitative PCR detection, and be the patient that 1 type HCV genotype infects.
4. any one purposes of claim 1-3, wherein the dosage of ribavirin is 400-1200mg every day, the dosage of interferon alpha 2 b is 200 ten thousand to 1,000 ten thousand IU weekly, with Zhou Jiwei on every Wendesdays time, the single administration next day of counting with day.
5. any one purposes of claim 1-3, wherein the dosage of ribavirin is 800-1200mg every day, the dosage of interferon alpha 2 b be 300 ten thousand IU on every Wendesdays time.
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